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PAST  A^HSTID  PRESENT 


IN  MICHIGAN. 


By  HENRI  B.  BAKER,  Secretary  State  Board  of  Health. 


[Reprinted  frorn  the  Annual  Report  of  the  Secretary  of  the  Michigan  State  Board  of  Health,  for  the 

Fiscal  Year,  1893.] 


[Reprint  No.  443.] 


PAST  AND  PRESENT  MOVEMENTS  FOR  SANITARY  PROGRESS  IN  MICHIGAN.* 


BY  HENRY  B.  BAKER,  SECRETARY  STATE  BOARD  OF  HEALTH,  LANSING. 


Mr.  President,  and  Members  of  the  State  Eclectic  Medical  and  Surgical 

Society : 

Gentlemen: — As  executive  officer  of  the  State  Board  of  Health,  I 
have  to  thank  you  for  the  invitation,  by  your  committee  of  arrangements, 
to  place  before  you  a statement  of  the  “Past  and  Present  Movements  for 
Sanitary  Progress  in  Michigan.”  On  account  of  the  long  period  of  time 
during  which  I have  been  engaged  in  “Movements  for  Sanitary  Prog- 
ress,” having  been  in  public-health  work  for  this  State  since  1870,  I 
shall  venture,  in  this  address,  to  comply  with  the  suggestion  of  the  Chair- 
man of  your  committee  of  arrangements,  and  suggest  a few  directions  in 
which,  according  to  my  judgment,  future  movements  for  sanitary  progress 
may  well  be  pushed. 

Vital  Statistics — Experience  has  proved,  I think,  that  the  collection 
of  statistics  relating  to  deaths  has  generally  led  to  movements  for  sani- 
tary progress.  In  Michigan,  an  effort  was  made,  by  Dr.  Foster  Pratt  and 
others,  as  long  ago  as  1857,  for  a State  law  providing  for  a system  of  Vital 
Statistics;  but  the  present  law  was  not  enacted  until  1867.  The  law  was 
amended  in  1869,  but  it  is  still  very  defective  in  that  the  deaths  are  not 
recorded  sometimes  until  more  than  a year  after  they  occur,  so  that  many 
are  forgotten  and  never  recorded.  The  law  should  be  so  amended  that  the 
essential  facts,  relating  to  each  person  who  dies,  shall  be  plaoed  upon 
record  immediately  after  the  death  occurs.  The  plan  recommended  by 
statisticians  is  to  require  such  records  to  be  made  before  a burial  permit  is 
issued.  In  order  that  the  statistics  shall  have  the  greatest  value,  the  law 
should  provide  that  the  records  of  the  causes  of  death — that  is  to  say  the 
name  of  the  disease  and  the  immediate  cause  of  death,  of  each  decedent 
shall  be  certified  by  a physician.  It  would  be  well  if  these  statistics  could 
be  collected  and  compiled  by  physicians;  because  if  it  is  done  by  non- 
prgfessional  persons  errors  are  usually  made  which  impair  the  value  of  the 
statistics.  Under  the  present  law  in  Michigan  they  are  collected  by  non- 
professional persons.  If  they  were  collected  by  the  health  officers  most 
of  the  errors  due  to  ignorance  of  professional  terms  would  be  avoided 
because  most  of  the  health  officers  in  Michigan  are  physicians. 

Notwithstanding  the  imperfections  in  the  law  for  their  collection,  the 
mortality  statistics  are  very  valuable.  The  omissions  in  the  returns  are 
probably  about  the  same  in  each  year,  so  that  one  year  can  profitably  be 
compared  with  another.  Probably,  as  a rule,  one  disease  is  about  as  well 
reported  as  another,  so  that  the  relative  importance  of  the  several  diseases 
can  be  learned  form  the  statistics.  The  same  may  be  true  as  regards  ages 
of  decedents,  so  the  relative  mortality  at  the  different  ages  may  perhaps 
be  accurately  learned.  Therefore,  it  must  not  be  concluded  that  because 

*A  paper  read,  by  invitation,  before  the  annual  meetiog  of  the  State  Eclectic  Medical  Society,  at 
LansiDg,  May  10. 1893. 


CX1V  STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1893. 


the  vital  statistics  are  Dot  perfect  they  are  not  useful.  The  point  I want 
to  make  is  that  it  would  not  cost  more  than  it  now  does  to  make  them 
almost  perfect,  and  that  ought  to  be  done. 

General  Surface  and  Subsoil  Drainage. — In  an  early  period  in  the 
history  of  Michigan,  commissioners  sent  here  from  Washington  to  inves- 
tigate -and  report  on  the  geographical  features  of  the  State,  reported  that 
the  State  was  of  no  value,  because  so  much  of  it  was  swampy.  Many 
years  later  the  U.  S.  Government  donated  large  amounts  of  land  for  drain- 
age purposes  in  Michigan.  When  this  was  a new  State,  Dr.  Wyman, 
member  of  the  State  legislature,  from  Lenawee  county,  introduced  a bill 
which  became  one  of  the  first,  if  not  the  very  first  general  law  for  the 
drainage  of  low  lands  in  Michigan.  Such  laws  have  now  been  in  force 
for  many  years,  and  have  been  a very  important  movement  for  the 
advancement  of  the  public  health.  The  drainage  laws  always  specify  that 
the  drainage  is  for  the  benefit  of  the  public  health.  During  the  early 
years  of  its  existence,  the  State  Board  of  Health  did  much  to  favor  the 
drainage  of  low  lands.  Dr.  Henry  F.  Lyster,  a member  of  this  Board, 
especially  devoted  much  time,  thought,  and  labor  to  this  subject,  and  sev- 
eral of  his  papers  attracted  considerable  attention.  Incidental  to  the  gen- 
eral progress  throughout  the  State,  immense  progress  has  been  made  in 
the  drainage;  thus  the  building  of  State  roads  and  the  building  of  rail- 
roads, with  ditches  on  either  side,  has  done  much  to  drain  the  surface. 
The  clearing  of  swamps,  for  agricultural  purposes,  has  done  much.  The 
tile  drainage  of  land  has  contributed.  One  result  of  all  this  work  is  that 
today  Michigan  is  the  best  State  in  the  Union,  as  a home  for  healthy, 
prosperous  people.  But  the  point  I especially  wish  to  make  is  that  the 
general  surface  and  sub-soil  drainage  of  the  soil  has  constituted  one  of  the 
most  important  “Movements  for  sanitary  progress”  which  has  occurred 
in  Michigan.  Those  of  you  who,  like  myself,  were  here  in  an  early  day 
will  remember  that  nearly  every  person  who  came  into  this  State  soon  had 
the  ague;  many  had  it  till  they  “wore  it  out”  as  the  saying  was  in  those 
days.  Now  it  is  very  different, — intermittent  fever  is  not  so  very  com- 
mon. Much  of  that  sickness  disappeared  many  years  ago.  But  intermit- 
tent fever  is  still  being  reduced, — this  movement  is  still  in  progress. 
Recently  I have  prepared  a diagram  for  the  Columbian  Exposition  show- 
ing the  great  reduction  in  the  sickness  from  intermittent  fever  in  Michi- 
gan in  recent  years;  and  I have  copies  of  that  diagram,  reduced  in  size, 
here  for  distribution.*  By  examining  it  you  will  see  that  whereas  during 
the  five-year  period,  1877-81,  the  per  cent  of  all  reports,  made  by  phy- 
sicians to  the  State  Board  of  Health,  whioh  stated  that  intermittent  fever 
was  under  observation,  was  81,  while  during  the  period  ten  years  later 
(1887-91)  the  per  cent  was  only  forty-three,  a reduction  of  nearly  half  of 
the  sickness  in  ten  years.  This  reduction  in  the  sickness  has  coincided 
with  and  followed  the  several  general  movements  for  the  surface  and  sub- 
soil drainage  of  the  soil,  some  of  which  movements  have  had  the  benefit 
of  the  public  health  as  the  avowed  object  of  the  work.  I believe  that  the 
reduction  in  the  sickness  has  been  caused  by  the  drainage,  and  by  the 
changes  associated  therewith.  These  ohanges  have  cost  much  money,  but 
the  money  values  of  the  results  are  immensely  greater;  and  the  value  of 
the  decrease  in  the  sickness  cannot  well  be  estimated.  It  is  safe  to  say 
that  the  heaviest  pecuniary  tax  upon  the  people  has  thereby  been  done 
away  with. 


♦ The  diagram  ie  printed  on  page  cxv. 


NO. 15.- DECREASE  OF  SICKNESS  FROM  INTERMITTENT  FEVER.  IN  MICHIGAN  . 


cxvi  STATE  BOARD  OP  HEALTH,— REPORT  OF  SECRETARY,  1893. 

The  State  Board  of  Health  Movement. — The  movement  for  the  cre- 
ation of  the  State  Board  of  Health  in  Michigan  began  in  1870.  I take 
great  pleasure  in  the  fact  that  I had  the  honor  of  starting  that  movement. 
One  of  the  first  articles  published  on  the  subject  was  in  the  “University 
Medical  Journal,”  then  published  at  Ann  Arbor.  One  of  the  lines  of 
thought  that  led  me  toward  the  idea  of  a State  Board  of  Health,  was  that 
so  thoroughly  impressed  upon  me  by  three  years  of  service  in  the  medical 
department  of  the  U.  S.  Army,  during  the  great  war.  In  the  army  the 
surgeon  is  paid  as  much  when  none  are  sick  as  if  all  are  sick;  his  interest 
and  his  training  lead  to  the  study  and  practice  of  army  hygiene.  Again, 
the  usefulness  of  general  officers  for  the  coordination  of  the  efforts  of  all 
small  organizations  is  strongly  taught  and  exemplified  in  the  army,  which 
without  such  general  organization  would  be  only  an  inefficient  mob. 
Before  the  establishment  of  the  State  Board  of  Health,  the  laws  of  Michi- 
gan provided  for  a board  of  health  in  every  township,  city  and  village  in 
Miohigan;  but  there  was  no  such  local  board  which  was  worthy  of  notice; 
not  even  in  the  largest  cities.  What  was  lacking  was  the  generalizing 
center,  to  put  life,  activity,  and  regularity  into  the  numerous  but  inactive 
local  boards.  The  State  Board  of  Health  was  needed  also,  to  collect 
important  facts  from  all  of  the  local  boards,  and  to  make  all  such  facts 
available  for  the  use  of  each  and  all  of  them.  The  State  Board  of  Health 
was  established  just  twenty  years  ago,  in  1873.  The  movement  for  the 
establishment  and  for  the  continuance  and  proper  maintenance  of  the 
State  Board  of  Health,  deserves  to  rank  as  one  of  the  most  important 
“Movements  for  Sanitary  Progress  in  Michigan.”  To  most  people,  who 
have  not  given  the  subject  special  attention,  this  will  be  more  apparent 
after  their  having  investigated  the  subject.  There  will  not  be  time  at  my 
disposal  at  this  time  to  enter  fully  into  the  investigation;  but  I wish  to 
mention  a few  facts  bearing  upon  this  subject: 

About  as  soon  as  the  State  Board  of  Health  was  established  it  began 
to  labor  for  the  restriction  of  scarlet  fever.  Some  (physicians  even) 
combated  its  teachings  to  the  people  that  scarlet  fever  was  a dangerous 
communicable  disease;  but  the  State  Board  of  Health  kept  right  on.  I 
have  here  copies  of  a diagram,  accurately  drawn  to  scale,  exhibiting  the 
deaths  per  ten  thousand  inhabitants  in  Michigan  before  and  since  the 
establishment  of  the  State  Board  of  Health,  as  shown  by  the  statistics  col- 
lected by  the  Secretary  of  State.*  The  mortality  statistics  are  collected, 
by  the  Secretary  of  State,  by  the  same  plan  now  as  before  the  establish- 
ment of  the  State  Board  of  Health.  There  has  not  been  any  material 
change  in  the  plan,  probably  not  much  change  in  the  results.  The  death- 
rate  from  scarlet  fever  since  the  establishment  of  the  State  Board  of 
Health  is  only  about  half  what  it  was  before.  One-half  the  mortality 
from  scarlet  fever  is  stopped,  prevented ; of  the  children  who  by  the 
former  death-rate  would  have  died  from  scarlet  fever,  one-half  now  live. 
A great  waste  of  life  and  treasure  has  thus  been  very  greatly  lessened. 

If  this  evidence  were  confined  to  the  mortality  statistics  only,  one  might 
still  question  whether  this  great  reduction  was  not  due  to  the  better  suc- 
cess of  physicians  in  treating  the  disease.  But  the  best  system  of  sick- 
ness statistics  in  the  World  has  been  built  up  by  the  Michigan  State 
Board  of  Health,  and  the  evidence  of  the  sickness  statistics  collected  by 
the  State  Board  of  Health,  confirms  the  mortality  statistics,  collected  by 


* The  diagram  is  printed  on  page  cxvii. 


4IVES  JAVED  FROM:  SCARLET  FEVER  (17  YEARS)  7,265;  WALL-POX  (17  YEARS)  L*2I>  TYP  HOlO  FEVER  (12  YEARS)  1,671 


'V*.. 


LIVES.  SAVED  BY  PUBLIC-HEALTH  WORK, 
COMPARISON  OF  DEATH-RATES  IN  MICHIGAN 
FROM  SCARLET  FEVER  AND  SMALL-POX  BE-* 
FORE  AND  SINCE  THE  STATE  BOARD  OF 
HEALTH  WAS  ESTABLISHED  AND  FROM  TY- 
PHOID FEVER  BEFORE  AND  SINCE  ITS  RE-  1 
STRICTION  WAS  UNDERTAKEN  BY  THE  STATt 
BOARD.  COMPILED  FROM  STATE  DEPART- 
MENTS “VITAL  STATISTICS'"  OF  MICHICAN. 


REPORTED  DEATHS  PER  10,000  INHABITANTS. 


typhoid  fever. 


SCARLET  FEVER. 


SMALL-POX . > 


1869-73. 


1674-90, 

(SINCE) 


1869-73. 


1674-90 

(SINCE) 


1869-78. 


1879-90. 


BEFORE 


(BEFORE) 


(BEFORE) 


(SINCE) 


4.85 


2.24 


cxviii  STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1893. 

the  Secretary  of  State.  And  it  proves  that  the  sickness  also  has 
been  reduced.  I have  here  copies  of  a diagram  exhibiting  by  months 
the  relative  amount  of  sickness  from  scarlet  fever  in  Michigan  in 
two  periods,  ten  years  apart,  namely  from  1877-81,  and  from  1887  to  1891. 
From  this  diagram  you  will  see  that  there  was  a great  reduction  in  the 
sickness  from  scarlet  fever — a decrease  of  over  one-half  of  the  sickness,  in 
recent  years.* 

By  other  systems  of  reports  to  the  State  Board  of  Health,  we  gain  a 
knowledge  of  how  this  great  reduction  in  the  sickness  from  scarlet  fever 
was  accomplished.  As  you  all  know,  the  law  provides  that  every  case  of 
"‘disease  dangerous  to  the  public  health”  must  be  reported  to  an  officer  of 
the  local  board  of  health.  The  law  also  requires  that  the  local  officer  shall 
Teport  to  the  State  Board  of  Health,  the  local  health  officer  being  required 
to  “keep  the  Secretary  of  the  State  Board  of  Health  constantly  informed” 
respecting  every  such  disease  in  the  local  health  officer’s  jurisdiction.  On 
receiving  notice  of  such  a disease,  there  is  sent,  from  the  Office  of  the 
State  Board  of  Health,  pamphlets  telling  how  to  restrict  that  particular 
disease  ; and  the  health  officer  is  requested  to  distribute  the  pamphlets  to 
the  neighbors  of  the  person  sick.  When  this  is  done,  some  of  the  neigh- 
bors of  a house  placarded  for  a dangerous  disease,  are  likely  to  read  the 
pamphlets,  and  then  be  more  ready  to  cooperate  with  the  health  officer  for 
the  restriction  of  the  disease  to  their  neighbor’s  house.  After  the  out- 
break is  over,  the  health  officer  is  required,  under  the  law,  to  report  the 
facts  to  the  State  Board  of  Health.  I have  here  copies  of  diagrams  which 
have  been  compiled  from  the  reports  made  by  the  health  offioers;  the  dia- 
grams are  accurately  drawn  to  scale,  and  exhibit  the  average  cases  and 
deaths  per  outbreak  in  all  outbreaks  in  which  isolation  and  disinfection 
were  neglected,  compared  with  all  outbreaks  in  which  isolation  and  disin- 
fection were  enforced. f You  will  see  that  there  has  been  a very  great  differ- 
ence between  those  outbreaks  in  which  isolation  and  disinfection  were 
neglected  and  those  in  which  these  measures  were  enforced.  The  total 
number  of  outbreaks  reported  during  the  five  years,  1886-90,  was  1,857. 
It  is  reasonable  to  believe  that  if  isolation  and  disinfection  had  not  been 
attempted,  all  outbreaks  would  have  averaged  as  did  those  in  which  these 
measures  were  neglected  (13.29  cases  and  .69  deaths  per  outbreak);  and 
that  if  in  all  the  outbreaks  isolation  and  disinfection  had  been  enforced, 
all  outbreaks  would  have  averaged  only  as  many  cases  and  deaths  as  did 
those  in  which  isolation  and  disinfection  were  enforced.  If  this  is  cor- 
rect, then  there  were  prevented  from  scarlet  fever  in  Michigan  during  the 
five  years,  1886-90,  over  thirteen  thousand  cases  of  sickness,  and  nearly 
seven  hundred  (690)  lives  were  saved. 

The  same  diagram  includes  the  evidence  relative  to  diphtheria,  concern- 
ing which  the  same  methods  of  work  are  employed  by  the  State  Board, 
and  nearly  the  same  by  the  local  boards  of  health  in  Michigan.  It  may 
be  seen  that  when  isolation  and  disinfection  were  neglected  the  average 
cases  of  diphtheria  were  about  the  same  number  as  were  the  cases  of  scar- 
let fever;  but  the  deaths  were  about  four  times  as  many  as  they  were  from 
scarlet  fever.  Also  that  the  indicated  prevention  of  sickness  and  the  saving 
of  lives  were  both  greater  from  diphtheria  than  from  scarlet  fever;  there 
having  been  over  fifteen  thousand  oases  of  sickness  from  diphtheria,  and 
over  twenty-seven  hundred  deaths  from  that  disease,  prevented  by  isola- 


* The  diagram  is  printed  on  page  cxix. 
t The  diagram  is  printed  on  page  cxxi. 


r DECREASE  OF  SICKNESS  FROM  SCARLET  FEVER,  IN  MICHIGAN 


Curees  rtpnsintt  ntj  Sit h, nest  from  Scarlet  Fever  in  JhicKigan  during  two  periods  of  gears, 
J&T7m&/t  end  1887-  ft.  During  Ihe  first  five- gear  period  the  average  per  cent  of  reports  is XI, 
during  lAf  Inti  fine-year  period  it  is  decrease  of  over  otic-half  of  the  sicKness. 

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* Indicating  mhal  per  cent  of  all  reports  received  sided  Hie  presence  of  starbel  fever  then  under  the 
obsrnt.lt on  aj  the  physician s reporting. 

_ QierflOQt)  wrrlUij  reports  of  stcKness  tort  received  for  the  first  pericd.and  over  XH-,000 for  the  last  period. 


cxx 


STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1893. 


tion  and  disinfection,  in  Michigan,  during  the  five  years  1886-90, 
inclusive. 

As  executive  officer  of  the  State  Board  of  Health,  it  is  a great  pleasure  to 
me  to  be  able  to  place  before  you  these  evidences  of  the  exceedingly 
important  work  which  has  been  done  by  the  local  health  authorities,  and 
the  people  of  Michigan  during  recent  years. 

So  far  as  relates  to  the  great  reduction  in  the  sickness  and  mortality 
from  scarlet  fever  and  diphtheria  in  Michigan,  it  is  not  mainly  due  to 
drainage  of  the  soil,  to  general  sanitary  improvements,  to  advances  in  the 
strictly  medical  soiences,  nor  to  improved  therapeutic  measures,  although 
there  have  been  great  advances  along  all  these  lines.  As  we  are  now  able 
to  prove,  the  reduction  in  those  diseases  has  been  due  mainly  to  two 
measures — isolation  and  disinfection. 

In  this  great  work,  the  part  which  the  State  Board  of  Health  has  had, 
is  the  education  of  the  people  generally  throughout  the  State,  concerning 
the  contagiousness  of  scarlet  fever  and  diphtheria,  the  facts  that  both 
these  diseases  can  be  restricted  by  isolation  and  disinfection,  and  in  the 
best  methods  for  accomplishing  these  measures.  The  statistics,  also,  col- 
lected by  the  Michigan  State  Board  of  Health,  have  done  much  to  plaoe 
all  these  facts  upon  a scientific  basis. 

The  methods  which  this  State  Board  employs  for  the  collection  of  data, 
and  the  spreading  of  information  throughout  the  State,  have  already  been 
mentioned.  These  methods  are  of  interest  to  all  who  enjoy  studies  in  the 
sooial  sciences;  but,  on  this  occasion,  we  have  time  only  to  glance  at 
them.  The  main  central  ideas,  relative  to  the  spreading  of  information, 
are  to  obtain,  at  the  time  of  the  occurrence  of  each  disease,  information, 
of  the  township,  city  or  village  in  which  each  disease  is ; and  to  secure, 
in  each  such  township,  city  or  village,  the  distribution  of  pamphlets  and 
diagrams  which  plainly  tell  just  how  to  restrict  and  prevent  the  disease 
whioh  is  then  and  there  present.  Sooner  or  later  every  portion  of  the 
State  thus  receives  this  information,  at  just  the  time  when  the  people  are 
most  interested  in  the  subject,  namely  at  a time  when  a dangerous  disease 
is  threatening  their  own  neighborhood.  These  methods  for  the  education 
of  the  people  of  Michigan,  as  to  what  to  do  to  be  saved  from  the  danger- 
ous communicable  diseases,  have  now  been  in  operation  for  many  years, 
and  it  is  believed  that  the  people  of  Michigan  are  much  better  informed 
on  these  subjects,  which  are  of  vital  consequence  to  their  happiness,  than 
they  would  be  if  such  methods  had  not  been  maintained. 

The  State  Board  of  Health  Aids  New  Health  Officers. — One 
more  function  of  the  State  Board  of  Health  may  well  receive  a passing 
notice;  I refer  to  its  aid  to  newly-appointed  health  officers.  There  are 
now  in  Michigan  about  fifteen  hundred  health  officers.  In  every  year  a 
few  hundreds  of  these  go  out  of  office,  other  officers  take  their  places, 
some  of  whom  are  entirely  new  to  the  work,  and  have  much  to  learn  in 
order  best  to  guard  the  life  and  health  of  the  people  in  their  jurisdictions. 
On  receiving  notice  of  the  appointment  of  such  officers,  the  State  Board 
sends  to  each  such  health  officer,  a number  of  diagrams,  blanks,  and  pam- 
phlets which,  if  carefully  studied,  will  enable  the  local  health  officer  to 
have  a good  knowledge  of  the  laws  relating  to  the  public  health,  and  of 
the  best  known  methods  for  dealing  with  each  of  the  most  important  sub- 
jects with  which  the  local  health  officer  usually  has  to  deal. 

The  Movement  for  Better  Quarantine. — In  1885  cholera  was  threat- 
ening this  country,  and  the  legislature  of  Michigan  enacted  a law  giving 


ISOLATION  AND  DISINFECTION  RESTRICTED 
SCARLET  FEVER  AND  DIPHTHERIA  IN  MICHI- 
GAN DURING  THE  5 YEARS  1886-90. 


SCARLET  FEVER. 

ISOLATION  AND  DISINFECTION 

neglected.inI1ewforced.in 


DIPHTHERIA. 

ISOLATION  AND  DISINFECTION 
NECLECTEDt  INENFORCED,  IN 


.366  OUTBREAKS, 
AVERACE 


361  OUTBREAKS, 
AVERAGE 


CASESDEATHS  CASES. 


317  OUTBREAKS, 
AVERACE 


CASES  DEATHS 


252  OUTBREAKS, 
AVERAGE 


CASES  DEATHS. 


TOTALS  tO  UTBREAK  8,1,85  7;CA8ES,N, 31 2sDEATHS,5  9 1 
INDICATED  SAVING  OF  CASES  13.29  X 1,857  * IF, 312  s I3,3'b8' 
INDICATED  SAVINC  OF  LIVES  .69  X 1,857  • 591  : 690 

%\eik4*i  Culkrte**  rlitritf  Vlyiu ted"  »r  ‘fnjtmJ 


TOTALS. OUTBREAKS, l.985iCAS£S. II, 634|DE  AT  HS.2.S7t  { 
IN  OICATEO  SAVINC  OF  CASES  13.57  X 1.99511,634:18,302 
INDICATED  SAVINC  OF  LIVES  2.67  X 1,985-2,870:2.722 


cxxii  STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1893, 

to  the  State  Board  of  Health  power  and  money  to  maintain  a quarantine 
system.  It  so  happened  that  the  law  was  made  useful  for  the  prevention 
of  the  introduction  of  other  diseases  which  endanger  the  public  health, 
and,  although  cholera  did  not  enter,  there  was  soon  greater  need  for  efforts 
to  prevent  the  introduction  of  small-pox,  which  in  1885  was  epidemic  in 
Montreal.  Active  measures  were  then  taken  under  that  law,  and,  although 
small-pox  spread  to  nearly  every  State  near  by,  spreading  to  nine  States, 
no  case  came  into  Michigan  after  the  quarantine  was  established.  It 
should  be  acknowledged,  however,  that  the  case  which  started  the  epi- 
demic in  Montreal  was  that  of  a sleeping-car  conductor,  on  the  Grand 
Trunk  Railroad,  who  contracted  the  disease  in  Michigan,  it  having  been 
brought  from  the  State  of  New  York  before  the  quarantine  system  was  put 
in  operation. 

The  same  law  has  again  been  acted  upon,  since  September  last,  to  pre- 
vent the  introduction  of  cholera  and  other  dangerous  diseases.  And  it  is 
noteworthy  that  during  the  last  quarter  of  1892,  while  all  immigrants’ 
baggage  coming  into  Michigan  to  stay  was  being  disinfected,  the  sickness 
statistics  of  Michigan  show  that  there  was  an  unusually  small  amount  of 
sickness  in  Michigan  from  many  important  diseases.  This  decrease  in  the 
sickness  has  been  attributed  to  the  several  lines  of  work  done  in  Michigan 
with  reference  more  particularly  to  cholera,  such  as  the  disinfection  of 
immigrants’  baggage,  just  mentioned,  the  notices  to  local  health  officers, 
of  the  arrival  of  immigrants,  and  the  general  cleaning  up,  which,  in  many 
places  in  this  State,  followed  the  house-to-house  inspections  which  were 
carried  on  by  local  boards  as  has  long  been  recommended  by  this  State 
Board  of  Health. 

The  State  quarantine  law,  enacted  in  1885,  has  been  amended  and 
strengthened  by  the  present  legislature.  The  amendments  took  effect 
April  26,  1893. 

Present  Movements  for  Sanitary  Progress. — Although  the  duties  of 
the  State  Board  of  Health  are  the  fulfillment  of  the  laws  as  they  stand,  it 
would  be  strange  if  the  board  did  not  find  during  its  long-oontinued  labors 
how  laws  relating  to  the  public  health  could  be  greatly  improved,  in  some 
respects. 

Annual  Public  Sanitary  Meetings. — Among  the  several  movements 
for  sanitary  progress,  in  which  the  State  Board  is  now  much  interested, 
may  be  mentioned  the  proposed  law  providing  for  a public  meeting  of 
every  local  board  of  health,  with  the  citizens  of  its  locality,  just  before  the 
spring  election,  the  fixing  of  estimates  at  that  meeting,  for  work  and  for 
expenditures  during  the  coming  year,  and  the  making  of  reports,  to  the 
people,  of  the  work,  and  of  the  results  of  the  work  done  during  the  year 
then  about  to  close.  It  is  believed  that  if  such  a law  is  enacted,  it  will 
supply  the  means  whereby  sanitary  progress  in  Michigan  will  be  very 
greatly  promoted. 

Sanitary  Inspector,  and  Special  Investigation. — Whenever  glanders, 
rabies,  or  other  dangerous  disease  in  animals  occurs  in  Michigan,  the 
State  Live  Stock  Commission  is  able  to  send  the  State  Veterinarian  to 
make  a special  investigation,  and  to  recommend  or  take  action  for  the 
restriction  of  the  disease.  Much  good  has  been  thus  accomplished. 
Something  similar  has  been  done  by  the  State  Board  of  Health  relative 
to  diphtheria,  small-pox,  etc.,  but  the  requirements  relative  to  the  people 
are  much  greater  than  relative  to  animals,  because  there  are  so  many  more 
cases  of  disease,  and  more  localities  where  they  prevail.  And  the  duties 


SANITARY  PROGRESS  IN  MICHIGAN.  cxxiii 

. of  his  office  prevent  the  executive  officer  of  the  State  Board  of  Health 
from  visiting  so  many  localities.  There  is  a bill  before  the  legislature 
designed  to  make  a small  appropriation  to  pay  the  expenses  of  an  expert 
inspector  to  visit  and  aid  localities  in  investigating  the  causes  of  out- 
breaks of  diseases,  and  in  restricting  their  spread.  The  special  investiga- 
tions would  sometimes  involve  the  analysis  of  samples  of  water  from  dif- 
ferent sources,  the  examination  of  suspected  milk  supplies,  and  bacterio- 
logical examinations  to  verify  the  diagnosis  of  diphtheria,  cholera  or  other 
disease.  It  is  believed  that,  by  the  small  outlay  proposed,  the  causes  of 
many  outbreaks  now  unknown  could  be  brought  to  light,  dangerous  com- 
municable diseases  could  be  earlier  determined,  and  many  valuable  lives 
could  be  saved,  and  expenditures  by  the  people  reduced  more  than  the 
amount  of  the  appropriation. 

Past  and  Present  Movements  for  the  Regulation  of  the  Practice 
of  Medicine. — At  the  meeting  of  your  State  society  in  Lansing  two  years 
ago,  I see,  by  the  published  report,  that  you  had  under  consideration  the 
subject  of  the  regulation  of  medical  practice  in  Michigan.  This  is  a 
subject  in  which  I have  been  interested  since  1869,  when  I took  part  in  a 
discussion,  in  a legislative  committee  room  in  the  old  State  Capitol. 
Sanitary  progress  demands  that  the  discussion  go  on  until  the  legislature 
shall  enact  a law  which  shall  greatly  advance  the  standard  of  requirements 
of  medical  practitioners.  Under  present  conditions,  the  most  intelligent 
of  our  citizens  if  taken  suddenly  sick  and  unable  to  direct  who  shall  be 
employed,  are  liable  to  be  placed  under  the  care  of  imposters,  or  poorly- 
qualitied  practitioners. 

My  belief  is  that  no  good  law  will  be  enacted  until  doctors,  of  all 
classes,  good  and  bad,  cease  to  oppose  the  enactment  of  such  laws.  The 
quacks,  imposters,  and  incapables  all  oppose  such  a law.  I believe  they 
would  cease  their  opposition  if  they  could  be  brought  to  realize  what  I 
believe  is  the  truth,  that  their  own  interests  would  be  promoted  by  almost 
any  good  law;  because  no  law  would  interfere  with  any  such  class 
already  practicing.  Those  of  us  already  in  the  profession  need  not  fear 
that  we  would  be  interfered  with.  But  what  I wish  particularly  to  dwell 
upon  is  the  importance  of  guarding  one  movement  for  sanitary  progress 
from  injury  through  some  other  movement.  It  has  been  proposed  to  do 
in  Michigan  what  has  proved  so  disastrous  in  one  or  two  other  States, 
namely  combine  the  movement  for  the  regulation  of  medical  practice  with 
the  movement  for  the  maintenance  of  a State  Board  of  Health.  Wherever 
this  has  been  tried,  the  other  sanitary  work  which  ought  to  be  done  by  a 
State  Board  of  Health  has  fallen  far  short  of  what  it  should  have  been. 
This  is  a subject  which  involves  hundreds,  even  thousands  of  human  lives. 
Because  thousands  of  human  lives  have  already  been  saved  through  meas- 
ures which  the  Michigan  State  Board  of  Health  has  been  able  to  establish 
and  maintain,  which  could  not  have  been  maintained  if  this  Board  had 
been  hampered  with  the  execution  of  the  law  regulating  the  practice  of 
medicine.  Of  course,  it  is  true  that  the  regulation  of  the  practice  of  med- 
icine is  a movement  for  sanitary  progress,  it  is  a movement  whioh  will 
greatly  promote  the  public  health,  but  my  plea  is  that  the  execution  of 
such  a law  be  intrusted  to  a State  Board  specially  appointed  and  specially 
qualified  to  deal  with  that  important  movement.  For  my  own  part,  I 
should  prefer  to  have  some  of  the  members  of  such  an  examining  board, 
selected  from  among  the  teachers  in  the  several  medical  colleges;  but  I 
would  not  permit  any  single  college  to  control  the  entrances  to  the  profes- 


cxxiv  STATE  BOARD  OF  HEALTH.— REPORT  OF  SECRETARY,  1893. 

sion.  And  I would  be  content  with  a State  Board,  appointed  by  the  Gov- 
ernor and  Senate,  without  any  other  restriction  than  that  its  members 
should  be  reputable  physicians  or  surgeons.  Let  us  hope  that  all  classes 
of  people  will  soon  come  to  see  that  the  best  interests  of  all  demand  a law 
for  the  regulation  of  medical  practice.  Then  there  will  have  been  accom- 
plished one  more  movement  for  sanitary  progress  in  Michigan. 

Again,  I thank  you  very  cordially  for  this  opportunity  to  present  to  you 
this  theme;  and  I sincerely  hope  that  your  meeting  here  may  be  both 
profitable  and  pleasant. 


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